More than a week ago Donald Trump announced the selection of Rep Tom Price (R-GA), a Tea Party Conservative and unwavering Trump supporter, as his pick to head the Department of Health and Human Services. Price is an orthopedic surgeon from Atlanta who began focusing his energy on dismantling the Affordable Care Act (ACA) almost as soon as President Obama signed the legislation into law.
Price has already released a 242-page proposal for the “Empowering Patients First Act” designed to replace Obamacare. His intention is to wean 20 million Americans off Obamacare with a handful of tax credits, health care savings accounts to be financed by individual taxpayers, state grants to replace Medicaid and a variety of incentives to encourage competition within the insurance industry.
Central to his agenda is elimination of the ACA’s Medicaid expansion provision which 32 states, including Arizona, and the District of Columbia have bought into. This provision currently extends Medicaid coverage to some 9 million previously uncovered Americans with incomes slightly above the federal poverty level. To be blunt, Price’s determination to eliminate Medicaid coverage for 9 million needy Americans, including 400,000 Arizonans, appears to be both mean-spirited and despicable.
Under Price’s proposal the premium subsidies currently afforded most Obamacare enrollees will be replaced by tax credits ranging from $1,200 per year for people aged 18 to 35 to $3,000 for those 51 and over. Significantly these credits will be of absolutely no benefit to most low income people, and would hardly begin to cover the premiums and out-of-pocket costs for relatively comprehensive coverage in many regions of the country.
The health savings accounts in Price’s proposal will primarily benefit the affluent, and his proposal for addressing the insurance industry’s challenge in covering older and sicker Americans is fatally flawed. Essentially, Price would provide grants to each state to create “high risk pools” to help offset insurers’ losses when costs of catastrophic health care exceed their actuarial projections. In reality, however, he is seriously “low-balling” the scope of the problem by proposing to invest a mere $3 billion into state risk pools over a three-year period. By contrast, Ryan’s “Better Way” plan would provide $25 billion over the coming decade, and critics charge that this amount would prove to be woefully inadequate.
To make matters even worse, a recent Fiscal Times post states that “…the Price proposals would foster an insurance market very welcoming to young, healthy and financially self-sufficient people but hostile to sicker and older people.” While younger people would be able to save big-time bucks via bare bones coverage that eliminates currently mandated maternity and pediatric benefits, insurers would be permitted to jack up premiums and copayments to older enrollees by whatever the market will bear.
In the insurance industry this is known as “cherry picking”, a practice which as a public health professional I find to be totally unconscionable. And on top of all of this Paul Ryan, who will undoubtedly wield substantial power and influence in the Trump administration, wants to replace Medicare with a voucher system.
Promoting true health care reform
Health care spending as a percentage of GDP is virtually twice as high in America as in any other country. Yet our life expectancy ranks abysmally low in comparison with many other industrialized nations. Unarguably major illnesses impacting Americans today are largely lifestyle related. Most American have abrogated responsibility for their health and are entrenched in highly toxic lifestyles.
From the perspective of empowering people to take charge of their health, our so-called health care system is wired backwards. Over half of all resources are poured into treating the 5 percent of the population that constitutes the sickest of the sick.
As a culture we are heavily addicted to over-use of high end medical services. In truth, we do not have a health care system. Indeed, we have a heavily profit-oriented sickness care system. While the corporatization of health care has become highly profitable, disillusioned doctors and other health care professionals lament the demise of the caring dimension of health care and are leaving their professions in droves. This, in turn, is dangerously exacerbating the shortage of doctors in Arizona and elsewhere.
A massive paradigm shift toward creating a true health care system that both empowers and motivates citizens and health care providers to work together to create a nationwide culture of wellness must serve as the cornerstone of true health care reform.
Indeed, I am advocating that our newly elected president issue a “Clarion Call to Wellness” as the key plank of his health care reform strategy.
To truly make America great again, our nation both needs and deserves a presidential mandate to transform our profit dominated sickness care system into a true health care system that fully empowers both health care professionals and rank and file citizens to work together to enable our citizens to take charge of their health!
Accomplishing this goal will be a truly gargantuan undertaking, as our present “system” is controlled by entrenched propriety vested interests with immense political clout. Indeed, I challenge our newly elected president to take charge and appeal to the inherent good nature I believe lies at the core of every American, calling us all to band together to create a truly caring health care system.
Our nation needs and deserves a true health care system emanating from a national culture of wellness. Moving beyond our individual and collective vested interests we can create a health care system with a heart, a system in which doctors and other health professionals will work together with their patients, our educational system and rank and file citizens to motivate everyone to fully embrace a wellness lifestyle. Enlightened insurers and employers must step forth to play a key role in this transformation.
How will these massive reforms be financed? Quite simply, by weaning ourselves from our nationwide addiction to excessive high end medical treatment. Our nation’s leadership must somehow find ways to motivate the corporate sector that dominates American health care to embrace as their core mission the provision of compassionate and cost-effective health care for all Americans.
As a former senior level health policy analyst at a major university and a lifelong wellness advocate, I truly believe that through successfully motivating our nation’s people to assume full ownership of both our health and our excessive dependency on high end medical care, we could achieve a savings in inflation adjusted health care costs of 25 to 30 percent (or more) during our newly elected president’s first term. This, in turn, would secure the necessary funding to guarantee access to quality care for all Americans.
To accomplish this massive transformation, our newly elected president must be flanked by a Secretary of Health and Human Services who is ideologically attuned to this mission and truly up to the task.
Dr. John Newport is an author and socio-political commentator based in Tucson. He is a former senior level research associate in health policy analysis at the UCLA School of Public Health and author of “The Wellness-Recovery Connection” (Health Communications, Inc.) He can be reached at firstname.lastname@example.org.
The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.